Abdelhady Khaled, Durgam Samarth, Elzein Chawki, Ilbawi Michel N, Rhoiney David, Massad Malek G
Division of Cardiothoracic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Division of Cardiothoracic Surgery, University of Illinois at Chicago, 840 S. Wood St., CSB Suite 417 (MC 958), Chicago, IL, 60612, USA.
Pediatr Cardiol. 2017 Jun;38(5):1080-1083. doi: 10.1007/s00246-017-1581-1. Epub 2017 Feb 18.
The technique for successful surgical correction of an anomalous origin of the right coronary artery from the opposite aortic cusp with an aberrant course between the aorta and pulmonary artery is illustrated in a symptomatic 62-year-old woman. The intramural course of the right coronary artery traversed the tip of the commissure between the anterior and posterior leaflets, and its repair entailed unroofing of the intramural segment from inside the aortic intima. This technique required resuspension of the overlying commissure to maintain optimal aortic valve leaflet coaptation and prevent aortic insufficiency. Modifications of this technique have been utilized by us whenever the intramural segment traversed behind the commissure. In these cases, partial or subtotal unroofing of the intramural segment was performed to preserve the integrity of the intima behind the overlying commissure. More recently, we have performed the surgical correction by probing the intramural segment within the aortic wall to its most anterior location and then performing a wide anterior unroofing in the aortic intima, and marsupializing the aortic and coronary intima to avoid dissection or intimal flap development. We favor utilizing these techniques of anatomic correction of the anomalous coronary to other techniques involving coronary artery bypass grafting of the anomalous coronary, especially in adult patients, as unroofing provides more lasting results.
一名有症状的62岁女性展示了成功手术矫正右冠状动脉从对侧主动脉瓣叶异常起源并在主动脉和肺动脉之间走行异常的技术。右冠状动脉的壁内走行穿过前后叶之间的瓣叶交界尖端，其修复需要从主动脉内膜内部对壁内段进行开窗。该技术需要重新悬吊上方的瓣叶交界以维持最佳的主动脉瓣叶对合并防止主动脉瓣关闭不全。每当壁内段在瓣叶交界后方走行时，我们就会采用该技术的改良方法。在这些病例中，对壁内段进行部分或次全开窗以保留上方瓣叶交界后方内膜的完整性。最近，我们通过在主动脉壁内探查壁内段至其最前方位置，然后在主动脉内膜进行广泛的前方开窗，并将主动脉和冠状动脉内膜袋状化以避免夹层或内膜瓣形成来进行手术矫正。我们倾向于将这些异常冠状动脉解剖矫正技术用于涉及异常冠状动脉冠状动脉旁路移植的其他技术，尤其是在成年患者中，因为开窗能提供更持久的效果。
